Background: More than 5.5 million South Africans aged 30 years and older are at risk of chronic disease by virtue of their triglyceride levels (Maritz, 2006:101). Dyslipidaemia is common in westernized and industrialized communities (Steyn et al., 2000:720), especially so for South Africa, where burden of disease data show dyslipidaemia to be the second most prevalent of all the chronic conditions in the country (Council for Medical Schemes, 2006:48). It is therefore no surprise that at 3.3 per cent hipolipidaemics ranked second highest based on prevalence percentage per therapeutic group in the 2005 Mediscor medicines review on South African medical claims data (Bester et al., 2005:8-11). Hipolipidaemic drugs subsequently also ranked second highest for expenditure per therapeutic group, achieving a total expenditure of 5.8 per cent. Objective: The purpose of this study was to characterise the usage and cost of hipolipidaemic drugs in the private health care environment in South Africa based on various categories, including age, sex, prescriber type and generic indicator. Methods: A quantitative retrospective drug utilisation review was performed using dispensing records from a medicine claims database. Data for a two-year period (1 Jan. 2005 to 31 Dec. 2006) were used. Hipolipidaemic medicine usage was analysed according to five patient age strata: patients younger than 9 years, 10 ≤ 19 years, 20 ≤ 45 years, 46 ≤ 59 years and older than 59 years. Basic descriptive statistics such as frequencies and arithmetic mean (average) were used to characterise the study sample, and were calculated using the Statistical Analysis System (SAS®) for Windows 9.1® program (SAS Institute Inc., 2002-2003). Results: The database consisted of 19 860 593 and 21 473 062 medicine item claims for 2005 and 2006 respectively, at a total cost of R 1 893 376 921.00 (for 2005) and R2 046 944 383.00 (for 2006). Patients receiving hipolipidaemic medicine items represented about 7.2% of the total number of patients on the database in both 2005 and 2006. About 47% of the study population in both 2005 and 2006 was female, compared to 53% males. Hipolipidaemics represented between 3.1% (N = 19 860 593) and 3.3% (N = 21 473 062) of the total number of items claimed during the study period. The total cost of hipolipidaemics accounted for between 5.6% (N = R1 893 376 921.00) and 5.8% (N = R2 046 944 383.00) of the total cost of all medications claimed during the study period. The average cost per item of hipolipidaemics was R170.63 ± 70.19 in 2005 compared to R167.08 ± 71.93) in 2006. HMG-CoA reductase inhibitors formed the leading therapeutic class in hipolipidaemic medicine items in all age groups on the database, except for children aged 0 ≤ 9 years, where the “others” group, in particular cholestyramine (Questran Lite 4 mg) was claimed more frequently. Of the items claimed for both study periods, simvastatin was the most commonly claimed, accounting for 45.35% (n = 284 232) and 46.21% (n = 325 970) respectively of the number of hipolipidaemic items claimed, at a total cost of 30.97% (n = R33 119 294.18) and 31.38% (n = R36 983 938.41) for 2005 and 2006 respectively. Non-substitutable and generic hipolipidaemic medicine items carried the largest percentage of prevalence and cost in both study periods for both sex categories and all age groups. The majority of claims for hipolipidaemic medicine items were prescribed by general medical practitioners, followed by “other prescribers” and then by cardiologists. Only a small number of prescriptions claimed were prescribed by thoracic surgeons and even fewer by pharmacotherapists and pharmacists. Trade name products that were mostly prescribed were Lipitor and Adco-Simvastatin. Of all the hipolipidaemic drugs utilised on the database, only three active ingredients (bezafibrate, simvastatin and pravastatin) had generic equivalents available at the time of the study. With total substitution (100%) of these three drugs with the average price of the available generic hipolipidaemic equivalents on the database, a cost saving of R1 744 462.27 or 1.63% (N = R106 943 348.53) was possible in 2005. In 2006, a total cost saving of R1 526 985.79 or 1.30% (N = R117 862 631.87) was calculated. Conclusion: The study highlighted the most commonly prescribed hipolipidaemics within a sub-population of South African patients. The high average cost per prescription of hipolipidaemic drugs indicates that they are relatively expensive in comparison to other medications. Generic (and therapeutic) substitution should be investigated as potential cost-saving mechanisms in the private health care sector of South Africa. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2010.

Background: More than 5.5 million South Africans aged 30 years and older are at risk of chronic disease by virtue of their triglyceride levels (Maritz, 2006:101). Dyslipidaemia is common in westernized and industrialized communities (Steyn et al., 2000:720), especially so for South Africa, where burden of disease data show dyslipidaemia to be the second most prevalent of all the chronic conditions in the country (Council for Medical Schemes, 2006:48). It is therefore no surprise that at 3.3 per cent hipolipidaemics ranked second highest based on prevalence percentage per therapeutic group in the 2005 Mediscor medicines review on South African medical claims data (Bester et al., 2005:8-11). Hipolipidaemic drugs subsequently also ranked second highest for expenditure per therapeutic group, achieving a total expenditure of 5.8 per cent. Objective: The purpose of this study was to characterise the usage and cost of hipolipidaemic drugs in the private health care environment in South Africa based on various categories, including age, sex, prescriber type and generic indicator. Methods: A quantitative retrospective drug utilisation review was performed using dispensing records from a medicine claims database. Data for a two-year period (1 Jan. 2005 to 31 Dec. 2006) were used. Hipolipidaemic medicine usage was analysed according to five patient age strata: patients younger than 9 years, 10 ≤ 19 years, 20 ≤ 45 years, 46 ≤ 59 years and older than 59 years. Basic descriptive statistics such as frequencies and arithmetic mean (average) were used to characterise the study sample, and were calculated using the Statistical Analysis System (SAS®) for Windows 9.1® program (SAS Institute Inc., 2002-2003). Results: The database consisted of 19 860 593 and 21 473 062 medicine item claims for 2005 and 2006 respectively, at a total cost of R 1 893 376 921.00 (for 2005) and R2 046 944 383.00 (for 2006). Patients receiving hipolipidaemic medicine items represented about 7.2% of the total number of patients on the database in both 2005 and 2006. About 47% of the study population in both 2005 and 2006 was female, compared to 53% males. Hipolipidaemics represented between 3.1% (N = 19 860 593) and 3.3% (N = 21 473 062) of the total number of items claimed during the study period. The total cost of hipolipidaemics accounted for between 5.6% (N = R1 893 376 921.00) and 5.8% (N = R2 046 944 383.00) of the total cost of all medications claimed during the study period. The average cost per item of hipolipidaemics was R170.63 ± 70.19 in 2005 compared to R167.08 ± 71.93) in 2006. HMG-CoA reductase inhibitors formed the leading therapeutic class in hipolipidaemic medicine items in all age groups on the database, except for children aged 0 ≤ 9 years, where the “others” group, in particular cholestyramine (Questran Lite 4 mg) was claimed more frequently. Of the items claimed for both study periods, simvastatin was the most commonly claimed, accounting for 45.35% (n = 284 232) and 46.21% (n = 325 970) respectively of the number of hipolipidaemic items claimed, at a total cost of 30.97% (n = R33 119 294.18) and 31.38% (n = R36 983 938.41) for 2005 and 2006 respectively. Non-substitutable and generic hipolipidaemic medicine items carried the largest percentage of prevalence and cost in both study periods for both sex categories and all age groups. The majority of claims for hipolipidaemic medicine items were prescribed by general medical practitioners, followed by “other prescribers” and then by cardiologists. Only a small number of prescriptions claimed were prescribed by thoracic surgeons and even fewer by pharmacotherapists and pharmacists. Trade name products that were mostly prescribed were Lipitor and Adco-Simvastatin. Of all the hipolipidaemic drugs utilised on the database, only three active ingredients (bezafibrate, simvastatin and pravastatin) had generic equivalents available at the time of the study. With total substitution (100%) of these three drugs with the average price of the available generic hipolipidaemic equivalents on the database, a cost saving of R1 744 462.27 or 1.63% (N = R106 943 348.53) was possible in 2005. In 2006, a total cost saving of R1 526 985.79 or 1.30% (N = R117 862 631.87) was calculated. Conclusion: The study highlighted the most commonly prescribed hipolipidaemics within a sub-population of South African patients. The high average cost per prescription of hipolipidaemic drugs indicates that they are relatively expensive in comparison to other medications. Generic (and therapeutic) substitution should be investigated as potential cost-saving mechanisms in the private health care sector of South Africa. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2010.

Background: According to the Council of Medical Schemes of South Africa (CMS, 2007:52), nearly seventeen percent of the total benefits paid during 2006 were for medicine. Medicine is thus a cost-driving contributor to total healthcare financing. There are various factors influencing and driving medicine usage and cost patterns, including inter alia provider preference, therapeutic committees, marketing and cost. Objectives: The purpose of this study was to identify the top twenty trade name products according to total cost and prevalence in a section of the private health care sector of South Africa, and to identify cost driving products. Methodology: A quantitative, retrospective drug utilisation review (DUR) study was performed on computerised medication records (medicine claims data) for two consecutive years (i.e. 2005 and 2006) that were obtained from a South African pharmaceutical benefit management company (PBM). The study population consisted of 1 218358 and 1 259 099 patients for 2005 and 2006 respectively. A total of 19 860 679 and 21 473017 medicine items that were claimed during 2005 and 2006 were included in the review. Descriptive statistics were used to describe the data, and were analysed using the Statistical Analysis System® SAS 9.1® programme. The cost prevalence index (CPI), developed by Serfontein (1989:180), was used as an indicator of the relative expensiveness of medicine. Resource- and activity driver products (cost driving products) were identified on the database by calculating the total cost of the product, the CPI of the product as well as the prevalence of the product. Variables for analysis included age, gender, prescriber and provider types. Resurts and discussion: A total number of 8 522 574 and 9 046 138 prescriptions were analysed, with an average of 2.33 ± 1.56 and 2.37 ± 1.58 items per prescription during 2005 and 2006 respectively. The average cost per prescription for the total database was R222.16 ± R463.13 for 2005 and R226.25 ± R557.49 for 2006. Members had to co-pay an average of R26.33 ± R102.70 per prescription in 2005 compared to R29.74 ± R103.96 per prescription in 2006. Children under the age of nine accounted for approximately 13% of the total study population, the adolescent age group < 9 and ≥ 19 years) represented 12%, age group three < 19 and ≥ 45 years) represented 38%, age group four < 45 and ≥ 59 years) represented 21% and the geriatric age group (patients older than 59 years) represented 16% of the total study population on the database. About 44% of the study population were male compared to 56% female patients. The top twenty trade name products ranked according to total cost represented about 13% (N=R1 893376 921.00 and N=R2 046 944382.50 in 2005 and 2006 respectively) of the overall medicine cost. The top five trade name products according to total cost for 2005 in descending order were Upitor 1 Omg and 20mg, Fosamax 70mg, Celebrex 200mg and Prexum 4mg. During 2006 the top five trade name products were similar except for Cipralex 10mg in the place of Celebrex 200mg. The CPls for all these products were above one; these products were also all activity drivers. The top twenty trade name products ranked according to prevalence represented about 11% (N=19 860679 and N=21 473074) of the total medicine prevalence for both study periods. The top five trade name products according to prevalence for both years contained Eltroxin 100mcg, Ecotrin 81 mg, Upitor 10mg and Alcophyllex syrup, with Myprodol capsules in 2005 and Mybulen tablets in 2006. Upitor 1 Omg was the only cost driver product in this list. General medical practitioners prescribed the largest quantity of medicine items and represented about 73% of all the medicine items on the database. The medicine prescribed by general medical prescribers accounted for 65% of the overall medicine expenditure on the database. Pharmacies can be seen as the main providers of medicine items. Pharmacies provided approximately 80% of the medicine items and represented over 91% of the total medicine expenditure. Cardiovascular agents were the main pharmacological group that represented the greatest percentage of the total medicine cost, about 19% in both study years. Cardiovascular agents were also positioned 1st according to prevalence and represented about 14% of the overall medicine prevalence in both the study periods. Conclusions and recommendations: Cost driver products can be seen as the products that drives medicine expenditure in the managed health care environment, thus driving the total cost of medicine treatment in the private health care sector of South Africa. Through the implementation of managed health care information- and management instruments medicine expenditure can be reduced. Recommendations for future research have been made. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Background: Calcium channel blockers are mainly divided into antihypertensive and antianginal treatment agents. In 2000 it was estimated that 972 million adults worldwide were living with hypertension and it is expected to affect 1.56 billion patients by 2025. The incremental expenditure for the antihypertensive therapeutic group in the United States of America was estimated at $US 55 billion per annum in 2006. It was stated that around seven million people in the United States of America suffered from angina, with around 400 000 new reports every year. Objective: To determine the prescribing patterns of calcium channel blocker medicine items during 2005 to 2008 in a section of the private health care sector of South Africa. Methods: A retrospective quantitative drug utilisation review was done using a medicine claims database ranging over four years from 1 January 2005 to 31 December 2008. The total medicine claims database was divided into cardiovascular medicine items and then into calcium channel blockers. These were analysed according to age as well as gender. Further analysis included adherence of calcium channel blockers as well as an analysis of prescribers of these items during the study period. Results: The total number of patients on the medicine claims database consisted of 1 509 621 patients in 2005. This number decreased to 974 497 patients in 2008. The most medicine items were dispensed in 2006 (n = 21 113 422) with an average cost of R 92.82 (SD = 196.42) per medicine item. It was noted that 16.05% (n = 242 264) of patients used at least one cardiovascular item in 2005. The percentage of cardiovascular medicine item users increased by 4.36% during the study period to 20.41% (n = 198 847) in 2008. In 2008 the cardiovascular medicine items dispensed were responsible for 19.18% (R 342 565 308.41) of the total cost of all medicine items claimed. In 2005 the results revealed that 1.63% (n = 318 258) of all medicine items dispensed were calcium channel blocker medicine items. The percentage of calcium channel blockers increased to 2.24% (n = 367 437) of the total number of medicine items in 2008. The cost prevalence index was calculated for the calcium channel blockers and the value declined from 1.5 in 2005 to 1.22 in 2008, which indicated that the items dispensed were relatively expensive, but less than in 2005. An increase of 16.17% in the usage of generic medicine items were noted from 2005 to 2008. More female patients than male patients claimed medicine items during the study period. A higher percentage of male patients used a cardiovascular medicine item as well as calcium channel blockers during the study period compared to females and a larger percentage of their medicine expenditure was used on cardiovascular medicine items as well as calcium channel blockers compared to females. The usage of cardiovascular medicine items as well as calcium channel blocker medicine items increased with patient age. In 2008, 17.98% of patients older than 65 years of age used a calcium channel blocker compared to 0.97% of patients aged > 25 <= 35 years. Only 60.34% of calcium channel blockers items were used with acceptable refill adherence rates during the study. More than a third of the calcium channel blockers medicine items used had unacceptable low adherence rates from 2005 to 2008. In each of the study years the highest potential saving with generic substitution was seen with amlodipine containing items. It was also observed that some generic substitutions could be relatively more expensive than the innovator products and an increased cost instead of a saving through generic substitution may have occurred. Conclusion: This study highlighted the prescribing patterns and cost implications of calcium channel blockers in the private health care sector of South Africa. It is recommended that a more in–depth study of the adherence of calcium channel blockers be done. This study should also include the cost strategies of generic substitution of calcium channel blockers in South Africa. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Background: According to the Council of Medical Schemes of South Africa (CMS, 2007:52), nearly seventeen percent of the total benefits paid during 2006 were for medicine. Medicine is thus a cost-driving contributor to total healthcare financing. There are various factors influencing and driving medicine usage and cost patterns, including inter alia provider preference, therapeutic committees, marketing and cost. Objectives: The purpose of this study was to identify the top twenty trade name products according to total cost and prevalence in a section of the private health care sector of South Africa, and to identify cost driving products. Methodology: A quantitative, retrospective drug utilisation review (DUR) study was performed on computerised medication records (medicine claims data) for two consecutive years (i.e. 2005 and 2006) that were obtained from a South African pharmaceutical benefit management company (PBM). The study population consisted of 1 218358 and 1 259 099 patients for 2005 and 2006 respectively. A total of 19 860 679 and 21 473017 medicine items that were claimed during 2005 and 2006 were included in the review. Descriptive statistics were used to describe the data, and were analysed using the Statistical Analysis System® SAS 9.1® programme. The cost prevalence index (CPI), developed by Serfontein (1989:180), was used as an indicator of the relative expensiveness of medicine. Resource- and activity driver products (cost driving products) were identified on the database by calculating the total cost of the product, the CPI of the product as well as the prevalence of the product. Variables for analysis included age, gender, prescriber and provider types. Resurts and discussion: A total number of 8 522 574 and 9 046 138 prescriptions were analysed, with an average of 2.33 ± 1.56 and 2.37 ± 1.58 items per prescription during 2005 and 2006 respectively. The average cost per prescription for the total database was R222.16 ± R463.13 for 2005 and R226.25 ± R557.49 for 2006. Members had to co-pay an average of R26.33 ± R102.70 per prescription in 2005 compared to R29.74 ± R103.96 per prescription in 2006. Children under the age of nine accounted for approximately 13% of the total study population, the adolescent age group < 9 and ≥ 19 years) represented 12%, age group three < 19 and ≥ 45 years) represented 38%, age group four < 45 and ≥ 59 years) represented 21% and the geriatric age group (patients older than 59 years) represented 16% of the total study population on the database. About 44% of the study population were male compared to 56% female patients. The top twenty trade name products ranked according to total cost represented about 13% (N=R1 893376 921.00 and N=R2 046 944382.50 in 2005 and 2006 respectively) of the overall medicine cost. The top five trade name products according to total cost for 2005 in descending order were Upitor 1 Omg and 20mg, Fosamax 70mg, Celebrex 200mg and Prexum 4mg. During 2006 the top five trade name products were similar except for Cipralex 10mg in the place of Celebrex 200mg. The CPls for all these products were above one; these products were also all activity drivers. The top twenty trade name products ranked according to prevalence represented about 11% (N=19 860679 and N=21 473074) of the total medicine prevalence for both study periods. The top five trade name products according to prevalence for both years contained Eltroxin 100mcg, Ecotrin 81 mg, Upitor 10mg and Alcophyllex syrup, with Myprodol capsules in 2005 and Mybulen tablets in 2006. Upitor 1 Omg was the only cost driver product in this list. General medical practitioners prescribed the largest quantity of medicine items and represented about 73% of all the medicine items on the database. The medicine prescribed by general medical prescribers accounted for 65% of the overall medicine expenditure on the database. Pharmacies can be seen as the main providers of medicine items. Pharmacies provided approximately 80% of the medicine items and represented over 91% of the total medicine expenditure. Cardiovascular agents were the main pharmacological group that represented the greatest percentage of the total medicine cost, about 19% in both study years. Cardiovascular agents were also positioned 1st according to prevalence and represented about 14% of the overall medicine prevalence in both the study periods. Conclusions and recommendations: Cost driver products can be seen as the products that drives medicine expenditure in the managed health care environment, thus driving the total cost of medicine treatment in the private health care sector of South Africa. Through the implementation of managed health care information- and management instruments medicine expenditure can be reduced. Recommendations for future research have been made. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

Background: Calcium channel blockers are mainly divided into antihypertensive and antianginal treatment agents. In 2000 it was estimated that 972 million adults worldwide were living with hypertension and it is expected to affect 1.56 billion patients by 2025. The incremental expenditure for the antihypertensive therapeutic group in the United States of America was estimated at $US 55 billion per annum in 2006. It was stated that around seven million people in the United States of America suffered from angina, with around 400 000 new reports every year. Objective: To determine the prescribing patterns of calcium channel blocker medicine items during 2005 to 2008 in a section of the private health care sector of South Africa. Methods: A retrospective quantitative drug utilisation review was done using a medicine claims database ranging over four years from 1 January 2005 to 31 December 2008. The total medicine claims database was divided into cardiovascular medicine items and then into calcium channel blockers. These were analysed according to age as well as gender. Further analysis included adherence of calcium channel blockers as well as an analysis of prescribers of these items during the study period. Results: The total number of patients on the medicine claims database consisted of 1 509 621 patients in 2005. This number decreased to 974 497 patients in 2008. The most medicine items were dispensed in 2006 (n = 21 113 422) with an average cost of R 92.82 (SD = 196.42) per medicine item. It was noted that 16.05% (n = 242 264) of patients used at least one cardiovascular item in 2005. The percentage of cardiovascular medicine item users increased by 4.36% during the study period to 20.41% (n = 198 847) in 2008. In 2008 the cardiovascular medicine items dispensed were responsible for 19.18% (R 342 565 308.41) of the total cost of all medicine items claimed. In 2005 the results revealed that 1.63% (n = 318 258) of all medicine items dispensed were calcium channel blocker medicine items. The percentage of calcium channel blockers increased to 2.24% (n = 367 437) of the total number of medicine items in 2008. The cost prevalence index was calculated for the calcium channel blockers and the value declined from 1.5 in 2005 to 1.22 in 2008, which indicated that the items dispensed were relatively expensive, but less than in 2005. An increase of 16.17% in the usage of generic medicine items were noted from 2005 to 2008. More female patients than male patients claimed medicine items during the study period. A higher percentage of male patients used a cardiovascular medicine item as well as calcium channel blockers during the study period compared to females and a larger percentage of their medicine expenditure was used on cardiovascular medicine items as well as calcium channel blockers compared to females. The usage of cardiovascular medicine items as well as calcium channel blocker medicine items increased with patient age. In 2008, 17.98% of patients older than 65 years of age used a calcium channel blocker compared to 0.97% of patients aged > 25 <= 35 years. Only 60.34% of calcium channel blockers items were used with acceptable refill adherence rates during the study. More than a third of the calcium channel blockers medicine items used had unacceptable low adherence rates from 2005 to 2008. In each of the study years the highest potential saving with generic substitution was seen with amlodipine containing items. It was also observed that some generic substitutions could be relatively more expensive than the innovator products and an increased cost instead of a saving through generic substitution may have occurred. Conclusion: This study highlighted the prescribing patterns and cost implications of calcium channel blockers in the private health care sector of South Africa. It is recommended that a more in–depth study of the adherence of calcium channel blockers be done. This study should also include the cost strategies of generic substitution of calcium channel blockers in South Africa. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Abstract not available